- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.12 / $395.90 / $395.90
| Professional | | $343.12 | $395.90 | $395.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.30 / $485.64 / $553.63
| Professional | | $422.30 | $485.64 | $553.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.77 / $279.77 / $279.77
| Professional | | $279.77 | $279.77 | $279.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $527.87 / $607.04 / $791.81
| Professional | | $527.87 | $607.04 | $791.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.71 / $242.82 / $422.05
| Professional | | $221.71 | $242.82 | $422.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.94 / $419.66 / $419.66
| Professional | | $263.94 | $419.66 | $419.66 |